John Gondwe (not real name) is a 45-year-old man. He is a family man with two children. He used to work at Mchenga Coal Mines in Rumphi District. He was a hard worker hauling hundreds and hundreds of wheelbarrows of coal from the bellies of the earth.
Poor provision of Personal Protective Equipment (PPE) exposed Gondwe to the coal dust during the 10 years he had worked at the mine.
His health started deteriorating. Gondwe’s output went down. He was no longer the hard-working Gondwe. He was removed from the list of those doing manual work. Gondwe’s earnings got low. His body continued losing mass. Gondwe was a shadow of himself. He went to Rumphi District Hospital and was diagnosed with Pulmonary Tuberculosis as well as HIV. He was put on treatment immediately.
A lab technician putting samples in a machine
Two months of treatment passed but Gondwe’s condition did not improve. Further tests were done to establish why he was not responding to treatment and the results were negative.
Gondwe’s case coincided with the introduction of a new diagnostic tool called GeneXpert in 2012. This is a WHO-recommended technology for the molecular diagnosis of TB. It is also used to test resistance or how a patient can respond to anti-TB treatment.
A lab technician took Gondwe’s sputum to GeneXpert and the results came out in less than two hours which showed that the patient had Multi Drug Resistant TB. A few months later Gondwe got better and went back to his work.
Tuberculosis remains one of the major health challenges that has worsened with the emergence of multi-drug resistant (MDR) Tuberculosis strains that are resistant to normal TB drugs. Globally, the impact of Tuberculosis is significant, with an annual estimate of 9.6 million tuberculosis cases and over 1.5 million deaths due to tuberculosis in 2014.
Provisional results from the national TB prevalence survey completed in 2014 showed a higher TB prevalence of 1014 per 100,000 compared to the previously estimated prevalence of 373 per 100,000 by the World Health Organization (WHO).
Reports indicate that Malawi has a high HIV burden, with an estimated One Million HIV-positive people. One major cause of morbidity and mortality in people living with HIV is Tuberculosis. It is estimated that of all Tuberculosis cases, 41% are smear-negative and 64% are HIV co-infected.
Diagnosis of Tuberculosis continued to be a major challenge in Malawi due to the widespread use of diagnostics with poor sensitivity, such as sputum smear microscopy. Health experts say misdiagnosis or delayed detection of the disease results in many deaths and suffering.
Medical experts however say the introduction of GeneXpert has eased some of the challenges faced in the diagnosis of various diseases including TB. Years after the introduction of the tool the experts have described the machine as a game changer in as far as diagnosis of diseases is concerned.
Medical Laboratory Technician at the Ministry of Health Billy Banda said GeneXpert technology has increased access to diagnosis and treatment, especially in diseases such as TB as it is quick and easy.
‘’It is accurate, sensitive and timely in terms of results feedback, a process we call turnaround time of results. GeneXpert has also made it easy to do Drug Susceptibility Testing (DST) on TB patients which is important to find out whether a patient can respond to treatment or not,’’ said Banda.
He further said this is important because patients who cannot respond to normal TB drugs need early detection for effective treatment.
Banda said the device comes in different sizes providing for a different number of samples to be tested simultaneously.
‘’We can use GeneXpert to do HIV EID testing which is Early Infant Diagnosis in children, viral load testing for people living with HIV, Hepatitis B virus, Papilloma Virus in women as well as COVID-19 testing,’’ said Banda adding that this is helpful especially areas where people cannot access some of the services.
Henry Nyirenda, Karonga District Tuberculosis Officer said the GeneXpert machine has helped the district hospital to increase the number of people receiving TB treatment.
‘’Being a border district, Karonga faces challenges in the fight against TB due to movement of people and this has led to an increase in MDR-TB patients,’’ said Nyirenda adding that GeneXpert is helping them to detect such cases early.
Reported by Henry Haukeya.